Pathogenetic therapy of acute intestinal infections in children: integrated approach
A.A. Ploskireva1, A.V. Gorelov1,2
1 Central Research Institute of Epidemiology, Moscow
2 Sechenov University, Moscow
Acute intestinal infections (AII) remain important for clinical practice. The leading pathogenetic syndromes in AII are: dehydration, destabilization of the microbiocenosis system and reduction of the protective properties of the intestinal mucosa mucin layer. The article presents the main approaches of evaluation of the dehydration severity and its correction, it shows the place of probiotics in therapeutic tactics and the selection criteria of strains. The most justified in the treatment of dehydration syndrome in children is the use of solutions with reduced osmolarity. Probiotic therapy should begin as early as possible after the onset of the disease and include strains of probiotics recommended by the international community. Cytomucoprotective therapy with the use of gelatin tannate (Adiarin®) has shown its efficacy and safety and can be recommended as part of an integrated pathogenetic therapy of acute intestinal infections in children.
Key words: acute intestinal infections, diarrhea, dehydration, probiotics, cytomucoprotective therapy, gelatin tannate, Adiarin®.
For citation: Ploskireva A.A., Gorelov A.V. Pathogenetic therapy of acute intestinal infections in children: integrated
approach // RMJ. Medical Review. 2018. № 8(II). P. 79–82.
References
1. Guarino А., Lo Vecchio A., Захарова И.Н. и др. Тактика ведения детей с острым гастроэнтеритом на догоспитальном этапе: внедрение международных рекомендаций в практику педиатра // РМЖ. Педиатрия. 2014. № 21. С. 1483–1488 [Guarino A., Lo Vecchio A., Zakharova I.N. i dr. Taktika vedeniya detey s ostrym gastroenteritom na dogospital’nom etape: vnedreniye mezhdunarodnykh rekomendatsiy v praktiku pediatra // RMZH. Pediatriya. 2014. № 21. S. 1483–1488 (in Russian)].
2. Sack D.A., Chowdbury A., Euso F.A. Oralregidratation in rotavirus diarrhea: a duble blind comparison of sucrose with glucoseelectrolyte solution // Lancet. 1978. № II. P. 80–82.
3. Горелов А.В., Милютина Л.Н., Усенко Д.В. Клинические рекомендации по диагностике и лечению острых кишечных инфекций у детей. Пособие для врачей. М., 2005. 106 с. [Gorelov A.V., Milyutina L.N., Usenko D.V. Klinicheskiye rekomendatsii po diagnostike i lecheniyu ostrykh kishechnykh infektsiy u detey. Posobiye dlya vrachey. M., 2005. 106 s. (in Russian)].
4. Hahn S., Kim S., Garner P. Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children // Cochrane Database Syst Rev(2). 2002. Vol. 1. CD002847.
5. Multicentre evaluation of reduced-osmolarity oral rehydration salts solution. International Study Group on Reduced-osmolarity ORS solutions // Lancet. 1995. Vol. 345(8945). P. 282–285.
6. Hahn S., Kim Y., Garner P. Reduced osmolarity oral rehydration solution for treating dehydration due to diarrhoea in children: systematic review // BMJ. 2001. Vol. 323. P. 81–85.
7. Alam N.H. Symptomatic Hyponatremia During Treatment of Dehydrating Diarrheal Disease With Reduced Osmolarity Oral Rehydration Solution // JAMA. 2006. Vol. 296. Р. 567–573.
8. Pringle K., Shah S.P., Umulisa I. et al. Comparing the accuracy of the three popular clinical dehydration scales in children with diarrhea // Int J Emerg Med. 2011. Vol. 4. Р. 58.
9. Кligler B., Cohrssen A. Probiotics // Am Fam Physician. 2008. Vol. 78(9). Р. 1073–1078.
10. Allen S.J., Martinez E.G., Gregorio G.V., Dans L.F. Probiotics for treating acute infectious diarrhoea // Cochrane Database Syst Rev. 2010. Vol. 11. CD003048.
11. González-Castro A.M., Martínez C., Salvo-Romero E. et al. Mucosal pathobiology and molecular signature of epithelial barrier dysfunction in the small intestine in Irritable Bowel Syndrome // J Gastroenterol Hepatol. 2017. Vol. 32(1). Р. 53-63.
12. Hutsko S.L., Meizlisch K., Wick M., Lilburn M.S. Early intestinal development and mucin transcription in the young poult with probiotic and mannan oligosaccharide prebiotic supplementation // Poult Sci. 2016. Vol. 95(5). Р. 1173–1178.
13. Mattar A.F., Teitelbaum D.H., Drongowski R.A. et al. Probiotics up-regulate MUC-2 mucin gene expression in a Caco-2 cell-culture model // Pediatr Surg Int. 2002. Vol. 18(7). Р. 586–590.
14. Szajewska H. Advances and limitations of evidence-based medicine—impact for probiotics // Ann Nutr Metab. 2010. Vol. 57 (suppl). Р. 6–9.
15. Rijkers G.T., Bengmark S., Enck P. et al. Guidance for substantiating the evidence for beneficial effects of probiotics: current status and recommendations for future research // J Nutr. 2010. Vol. 140 Р. S671–S676.
16. Szajewska H., Guarino A., Hojsak I. et al. Use of probiotics for management of acute gastroenteritis: a position paper by the ESPGHAN Working Group for Probiotics and Prebiotics // J Pediatr Gastroenterol Nutr. 2014. Vol. 58(4). Р. 531–539.
17. Плоскирева А.А., Руженцова Т.А., Щербаков И.Т. и др. Патогенетические аспекты цитомукопротективной терапии острых кишечных инфекций // Экспериментальная и клиническая гастроэнтерология. 2016. Вып. 125. № 1. С. 65–73 [Ploskireva A.A., Ruzhentsova T.A., Shcherbakov I.T. i dr. Patogeneticheskiye aspekty tsitomukoprotektivnoy terapii ostrykh kishechnykh infektsiy // Eksperimental’naya i klinicheskaya gastroenterologiya. 2016. Vyp. 125. № 1. S. 65–73 (in Russian)].
18. Плоскирева А.А. Острые кишечные инфекции вирусной этиологии у детей клиника, диагностика и терапия: Автореферат дисс. ... докт. мед. наук. Центр. науч.-исслед. ин-т эпидемиологии МЗ РФ. М., 2016. 62 с. [Ploskireva A.A. Ostryye kishechnyye infektsii virusnoy etiologii u detey klinika, diagnostika i terapiya: Avtoreferat diss. ... dokt. med. nauk. Tsentr. nauch.-issled. in-t epidemiologii MZ RF. M., 2016. 62 s. (in Russian)]
19. Allegrini A., Costantini M. Gelatine Tannate for the Treatment of Acute Diarrhoea in Adults // J Gastrointest Digest Sys. 2012. Vol. 2. Р. 110.
20. Esteban Carretero J., Durbán Reguera F., López-Argüeta Alvarez S., López Montes J. A comparative analysis of response to vs. ORS + gelatin tannate pediatric patients with acute diarrhea // Rev Esp Enferm Dig. 2009 Jan. Vol. 101(1). Р. 41–48.
21. Машковский М.Д. Лекарственные средства: в 2-х тт. 12-е изд. М.: Медицина, 1993. С. 382–393 [Mashkovskiy M.D. Lekarstvennyye sredstva: v 2-kh tt. 12-ye izd. M.: Meditsina, 1993. S. 382–393 (in Russian)].
22. Angel M., Cohen A., Di Fulvio M. Патент EP 2526939 A1. Gelatine tan-nate and associations thereof for use in the treatment of inflammatory gastrointestinal diseases.
23. Frasca G., Cardile V., Puglia C. et al. Gelatin tannate reduces the proin-flammatory effects of lipopolysaccharide in human intestinal epithelial cells // Clin Exp Gastroenterol. 2012. Vol. 5. Р. 61–67.
24. Meloni M. New insights into the mechanism of action of Gelatine Tanate for Acute diarrhoea, protection against bacterial infection. Presented at the GFHGHP Congress, March 2012. Nantes, France.
25. Li S.T., Grossman D.C., Cummings P. Loperamide therapy for acute diarrhea in children: systematic review and meta-analysis // PLoS Med. 2007. Vol. 4. e98.
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